What Happens in a Balint Group?

A Balint group is an experiential, small group educational activity in which health care professionals discuss cases from their practices with a focus on the clinician-patient relationship or health professional – client relationship.Most Balint groups have a set membership of 8-12 participants who meet monthly for 1-2 hours.
Group participants sit in a circle, with a trained leader or two co-leaders. Clinicians present cases from their own practices. Group members listen to the presenter’s story, then discuss the case, with a focus on the clinician-patient relationship. Each presentation and discussion usually takes about 45 minutes, and groups often meet for 90 minutes.

The presenter tells the group about the case in an informal way, quite briefly, and without notes – because sometimes the way the story is told, including what is left out, can provide valuable clues to the nature of the presenter’s interaction with the patient. The presenter tries to convey the essence of how they experience the interaction with the patient and the atmosphere in the consulting room, to describe anything they are finding difficult and to include their own feelings and reactions.

The presenter is free to choose any patient to present. Often the patient presented will have have elicited strong feelings in the presenter, such as distress, frustration, surprise, difficulty, puzzlement or uncertainty.

In the group discussion, the group aims to explore the interaction between clinician and patient and to empathize with both of them. The group is encouraged to speculate, without any pressure to be “right”. The aim is to understand the situation in a deeper way, not to judge, advise, or offer solutions. It is important for the presenter to be protected from interrogation or criticism and to have time to listen and reflect on the group’s contributions. The atmosphere is mutually respectful and non-threatening. There is time to “sit” with uncertainty and complexity without the pressure to know the answer.

The clinician’s response to the patient often provides valuable clues about the patient’s psychological difficulties. Because of the diversity of group members’ varied personalities, life experiences and blind spots, there may be several ways of understanding the case. The group provides a place to express feelings – both pleasurable and painful. It provides camaraderie, intimacy and support. The presenter may find that in subsequent interactions with the patient, they are less defensive. They may find themselves increasing their repertoire of interventions and finding new approaches to recurring problems.

Participants develop better listening skills, observation skills and empathy. They develop increased self-awareness and capacity to reflect about themselves and they learn how useful it can be to examine their own reactions to patients. They experience the generativity of working as a group which is more than the sum of its parts. They become more creative, divergent and integrative in their thinking. They become more sensitive and skilled in addressing psychological aspects of their patients’ problems. They often develop increased professional satisfaction.